Syncope In Children

What is syncope?

Syncope (SING-kah-pe) is also called fainting, blacking out, or passing out. Syncope is a sudden loss of consciousness, followed by a fall from a standing or sitting position. Syncope is temporary (short-term). It is followed by an immediate, instant, and complete recovery even without treatment. Syncope is a very common symptom and can happen to any child. Syncope may also be a symptom of other diseases, such as heart conditions and neurologic (brain) diseases.

What causes syncope?

Syncope is caused by a decrease in blood flow to the brain. Oxygen is a part of our blood. When blood flow to the brain decreases, oxygen to the brain also decreases. Any of the following types of conditions may cause syncope:

• Reflex-mediated: This is the most common cause of syncope in children. This happens when there is a problem in the autonomic nervous system. The autonomic nervous system controls natural body functions, such as the heartbeat, blood pressure, and sweating. Syncope may occur when straining hard during bowel movements or urination. It can also happen during forceful coughing or sneezing, or when faced with a stressful or fearful situation.
  
  
• Cardiovascular: Syncope may be caused by heart diseases, such as problems in its arteries (blood vessels) or problems in the way the heart beats. Certain heart medicines may also cause fainting.
  
  
• Orthostatic: Suddenly changing positions can result in a sudden drop in blood pressure causing syncope. Position changes include moving from a lying down position to a sitting or standing position.
  
  
• Others: Diseases such as epilepsy and problems in the blood vessels of the brain can cause syncope. Children with emotional problems may have also have syncope.

What are the signs and symptoms found with syncope?

• Before syncope: Sudden signs and symptoms that usually last for 10 to 20 seconds may include:
  
  
  • Cold, clammy, and sweaty skin.
    
    
  • Fast breathing and a racing, pounding heartbeat.
    
    
  • Feeling sick to the stomach and throwing up
    
    
  • Light-headedness, dizziness, and headache.
    
    
  • Sudden body weakness.
    
    
  • Visual changes such as vision becoming blurred, dim, dark, or tunnel-like, or seeing black spots.
  
  
• During syncope: Your child loses consciousness that lasts from a few seconds to a few minutes. Your child may also have any of the following:
  
  
  • He may look pale or ashen.
    
    
  • He may wet himself with urine while passing out.
    
    
  • His body may be covered with sweat.
  
  
• After syncope: A rapid and full recovery usually occurs within one-half hour. Your child may have any of the following:
  
  
  • Dizziness, light-headedness, and a mild headache.
    
    
  • Feeling sick to the stomach.
    
    
  • Feeling tired more than the usual.

How is syncope diagnosed?

Your child may need the following tests:

• Blood tests: Your child may need blood tests to give caregivers information about how his body is working. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV.
  
  
• EEG: This test is also called an electroencephalogram. Many small pads or flat, metal buttons are put on your child's head. Each pad has a wire that is hooked to a machine. This machine records a tracing of brain wave activity from different parts of your child's brain. Caregivers look at the tracing to see how your child's brain is working.
  
  
• Echocardiogram: This test is also called an echo. Sound waves are used to show pictures of the size and shape of your child's heart. The echo can also show how well the heart is pumping and how well blood flows through it. Your child will lie down during the test. Caregivers will squirt clear gel onto your child's chest to help the echo probe move easily. The echo pictures are shown on a TV-like screen. The whooshing noise that you may hear is the sound of blood flowing through the heart. Caregivers may ask you to stay in the room with your child during this test.
  
  
• 12 Lead EKG: This test helps caregivers see your child's heart activity. It helps caregivers look for changes or problems in different areas of the heart. Sticky pads are placed on your child's chest, arms, and legs. Each pad has a wire that is hooked to a machine or TV-like screen. This machine shows a tracing of your child's heartbeat. This test takes about five to ten minutes. Your child must lie very still during the test.

Tilt table test:

If your child is having problems with fainting, he may need a tilt table test. This test checks to see what happens to your child's heart and his blood pressure when he changes positions.

How is syncope treated?

Your child may need any of the following:

• Education: Teaching him about the causes (sudden changes in position or straining) and symptoms of syncope may be important. Teaching your child certain actions may help him prevent another syncope event. This may include lying down, uncrossing your legs, or moving or pressing his arms or legs. Reassuring your child that his syncope is not caused by epilepsy or a heart problem may also be helpful.
  
  
• Fluid and salt intake: Increased intake of liquids and salt through salt tablets or sports beverages may prevent syncope.
  
  
• Medicines: There is no special medicine used to treat syncope. In certain cases where syncope occurs often, your child may need to take medicines. Medicines to help his heart pump strongly and regularly may be given. These medicines may also help control the activity of the autonomic nervous system or maintain blood circulation. Medicines to help keep fluid and salt inside your child's body, such as steroids, may also be given.

How can my child prevent syncope?

• If your child feels faint or dizzy, have him sit or lie down right away. Put his feet up higher than his head. This will get the blood flowing back to his heart and brain.
  
  
• Sudden movements may cause a fainting spell. Ask your child to move slowly and have him get used to one position before moving to another position. This is very important when changing from a lying or sitting position to a standing position.
  
  
• When getting up from a lying down position, have your child sit and take some deep breaths first before standing.
  
  
• If your child must sit or stand in one position for a long time, be sure he moves his legs often.
  
  
• Straining to have a bowel movement (BM) may cause your child to faint. If your child is constipated (having hard, dry stools that are difficult to pass), help him to avoid straining. Walking is the best way to get his bowels moving. Giving him foods high in fiber to make it easier to have a BM. Good examples are high fiber cereals, beans, vegetables, and whole grain breads. Prune juice may help make the BM softer.
  
  
• Have your child drink at least 8 to 10 (eight ounce) cups of healthy liquids each day. The best liquids to drink have water, sugar, and salt in them. These liquids help the body hold in fluid and help prevent dehydration (losing too much body fluid). Have your child drink even more liquids if he will be outdoors in the sun for a long time. Have him drink more liquids if he will be exercising a lot. Read the label on the can or bottle to see what the drink contains.
  
  
• Limit the amount of caffeine in your child's diet. Caffeine may make your child urinate too much and lose too much body fluid. Caffeine may be found in coffee, tea, soda pop, and some sports drinks and foods. Ask your caregiver what your child should drink if he is on a low salt or low sugar diet.
  
  
• Have your child wear a medical alert bracelet or necklace if he has a heart problem causing fainting spells. You can get one from:

• MedicAlert Foundation
  2323 Colorado Avenue
  Turlock , CA 95382
  Phone: 1- 888 - 633-4298
  Web Address: http://www.medicalert.org
  

What are the risks of having syncope?

Syncope may be a warning sign that your child has other health problems. Heart conditions and neurologic (brain) diseases may be causes of syncope and are often serious and may even cause death. Diagnosing and treating these conditions as soon as possible is needed to prevent further medical problems.

Where can I find more information?

Having syncope may be difficult for you, your child and your family to cope with. Contact the following for more information:

• American Heart Association
  7272 Greenville Avenue
  Dallas , TX 75231-4596
  Phone: 1- 800 - 242-8721
  Web Address: http://www.heart.org
  

• Heart Rhythm Society
  1400 K Street NW, Ste 500
  Washington , DC 20005
  Phone: 1- 202 - 464-3400
  Web Address: www.hrsonline.org
  

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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